The False War Between Therapies

There is a persistent narrative in psychotherapy that different modalities are in competition over first principles.

On one side: Aaron Beck and CBT with a structured, present-focused, empirically oriented aproach. On the other: Sigmund Freud and the psychodynamic tradition which is interpretive, historically grounded, concerned with unconscious processes.

What’s usually presented as a deep theoretical divide is often just a difference in language, emphasis, and explanatory style.

Because if two approaches—built on different assumptions about the mind—produce similar outcomes, then at least one of the following must be true:

• One theory is correct, and the other works accidentally

• Both theories are partially correct

• Or neither theory fully explains why therapy works

The field tends to avoid this conclusion. It continues to refine techniques within modalities rather than confront the possibility that the deeper mechanism of change sits beneath them.

What the Outcomes Suggest

Across decades of research, the pattern is stubborn: bona fide therapies tend to produce comparable results. CBT works. Psychodynamic therapy works. So do other modalities that, on the surface, look nothing alike.

This is not an argument that all therapies are equal. Some are clearly better than others. Some are incoherent. Some are fads dressed up in clinical language. But among legitimate approaches, the differences in outcome are often smaller than the differences in theory.

The principles governing personality—and how it changes—do not seem to vary by modality. What varies is the pathway used to access those principles.

Common Factors, Misunderstood

This observation gave rise to what is called the Common factors theory of psychotherapy: the idea that therapies work because of what they share, not because of what makes them unique.

Typically, these shared elements are listed as:

• The therapeutic relationship

• A credible explanation for the patient’s suffering

• A set of procedures that enact that explanation

• The patient’s expectation that change is possible

Without a theory of personality, “common factors” risks becoming a descriptive placeholder—a way of saying something important is happening here without specifying what.

What Actually Remains Constant

Strip away the branding, and therapies converge on a similar set of processes:

• They bring implicit patterns into awareness

• They create conditions where those patterns are experienced in real time

• They introduce disconfirming experiences

• They support the integration of those experiences into a revised sense of self

CBT does this through identifying and restructuring thoughts. Psychodynamic therapy does it through interpretation and relational patterns.

Where Therapies Actually Differ

The meaningful differences between therapies are not about whether they can work, but about:

• What they make visible vs. what they ignore

• What kinds of patients they are best suited for

• The kinds of errors they are prone to

CBT can become overly mechanistic—reducing complex emotional life to distorted thoughts and missing deeper relational patterns. Psychodynamic therapy can become overly interpretive—privileging insight while neglecting behavioral change or present-day functioning.

Why Failure Is More Revealing Than Success

Success in therapy tends to look similar: increased flexibility, improved emotional regulation, more stable relationships, a less rigid sense of self.

Failure, by contrast, is highly specific.

One therapy fails because it is too rigid. Another fails because it is too diffuse. One fails because it overwhelms the patient. Another fails because it never challenges them.

This asymmetry is captured cleanly by Leo Tolstoy’s observation: “Happy families are all alike; every unhappy family is unhappy in its own way.”

An Uncomfortable Implication

If different therapies work for overlapping reasons, then the field’s emphasis on modality-specific training is, at best, incomplete.

Clinicians are taught how to do a particular therapy.They are less often taught what must occur in the patient for any therapy to work.

The Real Divide

The real divide in psychotherapy is not between CBT and psychodynamic therapy.

It is between:

• Approaches that understand personality as the central object of change

• And approaches that operate without a clear model of what personality is

Everything else is secondary.